Remove Angina Remove Myocardial Infarction Remove Stents
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H/o MI and stents with brief angina has this ED ECG. And what is Fractional Flow Reserve?

Dr. Smith's ECG Blog

A middle-aged man complained of 15 minutes of classic angina that resolved upon arrival to the ED. So this is indeed diagnostic of myocardial infarction. Not immediately, at least, because this is NOT diagnostic of ACUTE (occlusion) myocardial infarction (Acute OMI). Angiogram: Widely patent RCA and LAD stents.

Angina 52
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Management and outcomes of spontaneous coronary artery dissection: a systematic review of the literature

Frontiers in Cardiovascular Medicine

of the patients were diagnosed with non-ST elevated myocardial infarction (NSTEMI), 36.8% with ST elevated myocardial infarction (STEMI), 3.41% with unstable angina, 0.56% with stable angina, and 0.11% were diagnosed with various types of arrhythmias. Approximately 48.5% and 1.3%, respectively.

SCAD 75
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Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Dr. Smith's ECG Blog

Patient is pain free and clearly has Wellens' syndrome: 1) pain free episode following an episode of angina, typical Pattern A (biphasic, terminal T-wave inversion with an initial upsloping ST Segment) findings, preserved R-waves. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction.

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GE HealthCare and Medis Medical Imaging Announce Collaboration Focused on Non-Invasive Coronary Assessments to Help Advance Precision Care in Treatment of Coronary Artery Disease

DAIC

The impact of this narrowing can ultimately result in angina (chest pain), which has been shown to double the risk of major cardiovascular events,1 as well as myocardial infarction ( heart attack ) or even death. Use Heart to Act on Angina. Available at: [link]. Accessed May 2024.

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Percutaneous Coronary Interventions Using a Ridaforolimus?Eluting Stent in Patients at High Bleeding Risk

Journal of the American Heart Association

Drug‐eluting stents have been shown to be superior to bare‐metal stents in patients with HBR, even when patients were given abbreviated periods of dual antiplatelet therapy (DAPT). Short DAPT has not been evaluated with the EluNIR ridaforolimus‐eluting stent.

Stents 40
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Three normal high sensitivity troponins over 4 hours with a "normal ECG"

Dr. Smith's ECG Blog

So there is probability of myocardial injury here (and because it is in the correct clinical setting, then myocardial infarction.) Thus, the patient does not (yet) get a formal diagnosis of MI and must be called unstable angina unless further troponins return above the 99th percentile. Repeat ECG is shown below.

Angina 123
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First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Dr. Smith's ECG Blog

A stent was placed. In my experience, all Wellens' with significant myocardial infarction have evolution from type A waves to type B waves over 6-24 hours' time , so that the presence of type A or type B waves, I believe, are simply a matter of the timing of recording and the rapidity of evolution. Lessons: 1. de Zwaan C.,